Contrary to common myth, people that self-injure rarely get pleasure from pain. They hurt themselves to bring relief from unresolved psychological pain. Therefore, merely paying attention to the surface injuries (the behaviour) is like sticking a plaster over the real wounds (the internal anguish). It temporarily brings relief or distraction from the inside hurt, but for lasting recovery the psychological wounds need to be addressed and healed.

This chapter provides guidelines for those working with self-injury and related issues (dissociation, recovered memories) whether in a professional or voluntary capacity. Contributions come from Bristol Crisis Service for Women (BCSW), and experienced practitioners Tracy Alderman and Karen Marshall, Rosemary Bray, and George F. Rhoades. Two case studies, along with respondents’ testimonies are included to highlight particular topics being discussed. To accommodate the contributors’ choice of terms ‘therapy’ and ‘counselling’ are used interchangeably, but essentially they mean the same.

Helpful Responses To Self-Injury

Short Term

• Show that you see and care about the person in pain behind the self-injury.
• Show concern for the injuries themselves. Whatever ‘front’ she may put on, a person who has injured herself is usually deeply distressed, ashamed, and vulnerable. You have an opportunity to offer compassion and respect – something different from what she may be used to receiving.
• Make it clear that self-injury is alright to talk about and can be understood. If you feel upset by the injuries, it may be best to be honest about this, while being clear that you can deal with your own feelings and don’t blame her for them.
• Convey your respect for the person’s efforts to survive, even though this involves hurting herself. She has done the best she could.
• Acknowledge how frightening it may be to think of living without self-injury. Reassure the person that you will not try to ‘steal’ her way of coping. (Also reassure yourself you are not responsible for what she does to herself.)

Longer-Term

• Help the person make sense of her self-injury, e.g. ask when the self-injury started, and what was happening then. Explore how it has helped the person to survive in the past and now. Retrace with her the steps leading up to self-injury – the events, thoughts and feelings which lead to it.
• Gently encourage the person to use the urge to self-injure as a signal – of important but buried experiences, feelings and needs. When she feels ready, help her learn to express these things in other ways, such as through talking, writing, drawing, shouting, hitting something, etc.
• Support the person in beginning to take steps to keep herself safe and to reduce her self-injury – if she wishes to. Examples of very valuable steps might be: taking fewer risks (e.g. washing implements used to cut, avoiding drinking if she thinks she is likely to self-injure); taking better care of injuries; reducing severity or frequency of injuries even a little. In all cases more choice and control are being exercised.
• Don’t see stopping self-injury as the only or most important goal. A person may make great progress in many ways and still need self-injury as a coping method for some time. Self-injury may also worsen for a while when difficult issues or feelings are being explored, or when old patterns are being changed. It may take a long time for a person to be ready to give up self-injury. Encourage her and yourself by acknowledging each small step as a major achievement.

© 1998 Bristol Crisis Service for Women (BCSW)
Used with permission

(See the resources section for further information about BCSW)

Working With Self-Injuring Clients